Health Encyclopedia

Erection problems

Definition:

An erection problem occurs when a man can't get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at all. Or, you may lose the erection during intercourse before you are ready. Erection problems usually don't affect your sex drive.

Erection problems are common. Almost all adult men have trouble getting or keeping an erection at one time or another. Often the problem goes away with little or no treatment. But for some men, it can be an ongoing problem. This is called erectile dysfunction (ED).

If you have trouble getting or keeping an erection more than 25% of the time, you should see your doctor.

Alternative Names:

Erectile dysfunction; Impotence; Sexual dysfunction - male

Causes:

To get an erection, your brain, nerves, hormones, and blood vessels all need to work together. If something gets in the way of these normal functions, it can lead to erection problems.

An erection problem is usually not "all in your head." In fact, most erection problems have a physical cause, such as:

Disease:

Diabetes

High blood pressure

Heart or thyroid conditions

Clogged arteries (atherosclerosis)

Depression

Nervous system disorders, such as multiple sclerosis or Parkinson's disease

Medicines

Antidepressants

Blood pressure medications (especially beta-blockers)

Heart medications (such as digoxin)

Sleeping pills

Some peptic ulcer medications

Other physical causes

Low testosterone levels. This can make it difficult to get an erection. It can also reduce a man's sex drive.

Nerve damage from prostate surgery.

Nicotine, alcohol, or cocaine use.

Spinal cord injury.

In some cases, your emotions or relationship problems can lead to ED, such as:

Poor communication with your partner.

Feelings of doubt and failure.

Stress, fear, anxiety, or anger.

Expecting too much from sex. This can make sex a task instead of a pleasure.

Erection problems can affect men at any age. But they are more common as you get older. Physical causes are more common in older men. Emotional causes are more common in younger men.

If you have erections in the morning or at night while you sleep, it's likely not a physical cause. Most men have 3 to 5 erections at night that last about 30 minutes. Talk with your doctor about how to find out if you have normal nighttime erections.

Common Causes:

An erection involves your brain, nerves, hormones, and blood vessels. Anything that interferes with these normal functions can lead to problems getting an erection.

Unrealistic sexual expectations, which make sex a task instead of a pleasure

Erection problems become more common with age. However, they can affect men at any age. Physical causes are more common in older men. Emotional causes are more common in younger men.

Low levels of testosterone can lead to erection problems. They may also reduce a man's sex drive.

Home Care:

For many men, lifestyle changes can help:

Cut down on smoking, alcohol, and illegal drug use.

Get plenty of rest and take time to relax.

Exercise and eat a healthy diet to keep good blood circulation.

Use safe sex practices to prevent HIV and STDs.

Talk openly to your partner about sex and your relationship. If you cannot do this, counseling can help.

Couples who cannot talk to each other are likely to have problems with sexual intimacy. Men who have trouble talking about their feelings may find it hard to share their anxiety about sexual performance. Counseling can help both you and your partner.

Call your health care provider if:

Call your doctor if:

The problem does not go away with lifestyle changes

The problem begins after an injury or prostate surgery

You have other symptoms, such as low back pain, abdominal pain, or a change in urination

If erection problems seem to be caused by a medication you are taking, talk to your health care provider. You may need to lower the dose or change to another drug. Do NOT change or stop taking any medications without first talking to your health care provider.

Talk to your health care provider if your erection problems have to do with a fear of heart problems. Sexual intercourse is usually safe for men with heart problems.

Call your doctor right away or go to an emergency room if the medication you are taking for erection problems gives you an erection that lasts for more than 4 hours.

What to expect at your health care provider's office:

Your doctor will perform a physical exam, which may include:

Checking your blood flow (circulation)

An exam of your penis and rectum

An exam of your nervous system

To help find the cause of the problem, your doctor will ask medical history questions such as:

Have you been able to get and keep erections in the past?

Are you having trouble getting an erection, or keeping erections?

Do you have erections during sleep?

How long have you had trouble with erections?

What medications are you taking (including prescription medications, over-the-counter medications, and recreational drugs)?

The treatment may depend on the cause of the problem. Talk to your health care provider about the best way to treat your erection problem.

There are many treatment options today, including:

Injections into the penis

Medicines inserted into the urethra

Medicines taken by mouth

Surgery

Vacuum devices

Ask your health care provider about the possible side effects and complications of each treatment.

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are medicines called phosphodiesterase-5 (PDE5) inhibitors. They work only when you are sexually aroused. They usually start to work in 15 to 45 minutes.

These drugs can have side effects, which can range from muscle pain and flushing to heart attack. Do not use these drugs with medications such as nitroglycerin. The combination can cause your blood pressure to drop. Some men have died after taking these drugs with nitroglycerin.

Use PDE5 inhibitors with caution if you have any of the following conditions:

Many herbs and dietary supplements are marketed to help sexual performance or desire. However, none of these supplements have been proven effective for treating erectile dysfunction, and they may not always be safe.